Dry Eye Disease

Question 1

Function of Tear film ?

Answer 1

1.Lubrication 🛡️ (reduces friction during blinking)
2.Optical clarity 🧊 (smooth surface for light refraction)
3.Protection 🧬 (contains antimicrobial proteins)
4.Nutrient delivery 🍽️ (especially to avascular cornea)

Question 2

3 Layers Of Tear film ?

Answer 2

1.Lipid Layer
2.Aqueous Layer
3.Mucin Layer

Question 3

Lipid Layer Produced by ?

Answer 3

Meibomian glands (tarsal plate)

Question 4

Function of Lipid layers ?

Answer 4

Prevents evaporation, smooths surface

Question 5

Aqueous Layer Produced by ?

Answer 5

Lacrimal gland (main + accessory)

Question 6

Function of Aqueous layers ?

Answer 6

Provides volume, nutrients, and defense

Question 7

Mucin Layer Produced by ?

Answer 7

Goblet cells (conjunctiva)

Question 8

Function of Mucin Layers ?

Answer 8

Adheres tears to epithelium, stabilizes tear film

Question 9

How to test Lipid Layer defect ?

Answer 9

Rapid TBUT (<10 sec)

Question 10

How to test Aqueous deficiency ?

Answer 10

Low Schirmer (<5 mm)

Question 11

How to test Mucin deficiency ?

Answer 11

Conjunctival staining

Question 12

How to test Lipid layer ?

Answer 12

Meibomian gland dropout

Question 13

🧠 How Many Types of Dry Eye Disease (DED) Are There?

Answer 13

2 Type

Question 14

🔬 2. Subtypes of Aqueous-Deficient Dry Eye

Answer 14

Based on Sjogren

Question 15

Risk factor for dry eye ?

Answer 15

Question 16

Why female have more dry eye ?

Answer 16

1.Androgen decrease
> MGD

Question 17

Explain the TFOS DEW II Flow chart

Answer 17

Question 18

What are Triaging question and why ?

Answer 18

Question 19

Vicous cycle of DED ?

Answer 19

Question 20

Describe Tear film instability ?

Answer 20

1.MGD > Lipid loss
2.Goblet cell loss > Mucin layer defect
leading to uneven tear distribution
> Rapid Breakup

Question 21

Describe Tear hyperosmolarity

Answer 21

Due to:

↓ Aqueous production or ↑ evaporation

Tear salt concentration becomes toxic to epithelial cells

🧪 Clinical test: Tear osmolarity > 308 mOsm/L or inter-eye difference > 8 mOsm/L
🧬 Activates MAPK, NF-κB → triggers cytokines → inflammation

Question 22

Describe Inflammation process in DED ?

Answer 22

Key cytokines: IL-1β, TNF-α, MMP-9

Leads to:

Epithelial cell apoptosis

Goblet cell loss (↓ mucin)

Lacrimal gland dysfunction (↓ aqueous)

Question 23

How can you detect Inflammation in DED ?

Answer 23

Detectable via:

InflammaDry (detects MMP-9)

Clinical signs: conjunctival hyperemia, corneal staining

Question 24

What is Neurosensory Dry eye ?

Answer 24

disruption or dysfunction of corneal sensory nerves
1. Neurotrophic > lasik , DM > Preservative-free tears, autologous serum, protect cornea
2. Neuropathic > More pain > Consider gabapentin, pregabalin, TCAs, refer to pain clinic

Question 25

Describe Vicious cycle and Treatment clinical corelation

Answer 25

Question 26

Describe DED pathophysioly based on DEWS II

Answer 26

Question 27

DED Stepwise Clinical approach ?

Answer 27

1.Symptoms Screening 2.Look for sign of tear instability 3.Asses ocular surface damage 4.Evaluate Tear Production 5.Examine Meibomian glands

Question 28

How will you Symptoms Screening of DED ?

Answer 28

Use Questionaire 1.OSDI 2.SPEED 3.DEQ-5 ( > 6 Suspected Sjogren )

Question 29

How look Look for sign of tear instability ?

Answer 29

TBUT ( < 10 sec ) NITBUT ( < 10 sec ) Tear osmolar ( > 308 or Diff > 8 )

Question 30

How Assess Ocular Surface Damage ?

Answer 30

Fluorescein - Corneal epithelial loss Lissamine Green - Conjunctival/goblet cell loss Rose Bengal - Damaged cells without mucin

Question 31

How Evaluate Tear Production ?

Answer 31

Schirmer I > no anes > Reflex + Basal tear Schirmer II > with anes > Basal tear Phenol red > Alternative to Schirmer

Question 32

Describe Treatment of DED

Answer 32

Step 1: Lifestyle & Environment (All Patients) Step 2: Tear Supplements (Artificial Tears) Step 3: Anti-Inflammatory Therapy Step 4: Treat the Subtype Specifically Step 5: Advanced / Surgical

Question 33

How to Treat Mild OSDI ?

Answer 33

1+2 Step 1: Lifestyle & Environment (All Patients) Step 2: Tear Supplements (Artificial Tears)

Question 34

How to Treat Moderate OSDI ?

Answer 34

Step 2: Tear Supplements (Artificial Tears) Step 3: Anti-Inflammatory Therapy

Question 35

How to Treat severe OSDI ?

Answer 35

Step 3: Anti-Inflammatory Therapy Step 4: Treat the Subtype Specifically Step 5: Advanced / Surgical

Question 36

What is Step 1: Lifestyle & Environment (All Patients) ?

Answer 36

Question 37

What is Step 2: Tear Supplements (Artificial Tears)

Answer 37

Question 38

Step 3: Anti-Inflammatory Therapy This step breaks the vicious cycle:

Answer 38

Question 39

What is Step 4: Tear Supplements (Artificial Tears)

Answer 39

Question 40

How to treat for Aqueous-deficient DED ?

Answer 40

Question 41

What is Step 5: Advanced / Surgical ?

Answer 41